Introduction: Coronavirus disease 2019 (COVID-19) has developed into a severe public health concern. The present study was aimed to evaluate the related preventive behaviors to COVID-19, and associated factors among Iranians based on the constructs of the Health Belief Model (HBM).
Methods: This cross-sectional study was conducted between March and April 2020 among Iranians. Data of 1020 people were collected and analyzed. Data were collected by a self-administered questionnaire based on the constructs of HBM and also a demographics questionnaire. Simple and multivariable linear regression models were used to determine the predictors of preventive behaviors concerning COVID-19. A P-value of less than 0.05 was considered significant.
Results: The mean score of preventive behaviors concerning COVID-19 was 51.3±7.25. 72.8% (95% confidence interval (CI): 69.9%-75.4%), and 24.3% (95% CI: 21.7%-27.0%) of the participants exhibited a high, and moderate level of preventive behaviors, respectively. 75.1% of the participants would always/often wear face masks out home or in crowded places. The most common preventive behaviors were using of personal belongings in the workplace or at home (96.1%) and staying at home except for very necessary or for work (92.9%). Results showed that all six HBM constructs, i.e., perceived susceptibility (B=0.14, P<0.001), perceived severity (B=0.12, P<0.001), perceived benefits (B=0.25, P<0.001), perceived barriers (B=-0.12, P=0.001), cues to action (B=0.16, P<0.001), and self-efficacy (B=0.26, P<0.001) were significant predictors of related preventive behaviors to COVID-19. Female gender was another predictor of preventive behaviors (B=2.27, P<0.001).
Conclusions: This study demonstrated the effectiveness of HBM constructs in predicting COVID-19 preventive behaviors. Therefore, the model as a framework for designing training programs for improving health behaviors among Iranians during the COVID-19 pandemic seems to be helpful.
2. World Health Organization. Novel Coronavirus–China. 2020 [updated 12 January 2020; cited 2020 12 May]; Available from: https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/.
3. World Health Organization. Coronavirus disease (COVID-19) Pandemic. [cited 2020 May 12]; Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
4. Viswanath A, Monga P. Working through the COVID-19 outbreak: rapid review and recommendations for MSK and allied heath personnel. Journal of Clinical Orthopaedics and Trauma. 2020;11(3):500-3.
5. Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2020:1-14.
6. Lau JTF, Kim JH, Tsui HY, Griffiths S. Perceptions related to bird-to-human avian influenza, influenza vaccination, and use of face mask. Infection. 2008;36(5):343-443.
7. MacIntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, et al. Face mask use and control of respiratory virus transmission in households. Emerging infectious diseases. 2009;15(2):233.
8. Nemcek MA. Health Beliefs and Preventive Behavior a Review of Research Literature. Aaohn Journal. 1990;38(3):127-38.
9. Najimi A, Golshiri P. Knowledge, beliefs and preventive behaviors regarding Influenza A in students: a test of the health belief model. Journal of education and health promotion. 2013;2:23.
10. Rosenstock IM. Historical origins of the health belief model. Health education monographs. 1974 2(4):328-35.
11. Jones CL, Jensen JD, Scherr CL, Brown NR, Christy K, Weaver J. The health belief model as an explanatory framework in communication research: Exploring parallel, serial, and moderated mediation. Health communication. 2015;30(6):566-76.
12. Kwok KO, Li KK, Chan HH, Yi YY, Tang A, Wei WI, et al. Community responses during early phase of covid-19 epidemic, Hong Kong. Emerging Infectious Diseases journal. 2020;26(7):1-5.
13. Tang CSK, Wong CY. Factors influencing the wearing of facemasks to prevent the severe acute respiratory syndrome among adult Chinese in Hong Kong. Preventive Medicine. 2004;39(6):1187-93.
14. Tan NC, Goh LG, Lee SS. Family physicians' experiences, behaviour, and use of personal protection equipment during the SARS outbreak in Singapore: do they fit the Becker Health Belief Model? Asia Pacific Journal of Public Health. 2006;18(3):49-56.
15. Lau JT, Kim JH, Tsui HY, Griffiths S. Anticipated and current preventive behaviors in response to an anticipated human-to-human H5N1 epidemic in the Hong Kong Chinese general population. BMC Infectious Diseases. 2007;7(1):18.
16. Lau JT, Griffiths S, Choi KC, Lin C. Prevalence of preventive behaviors and associated factors during early phase of the H1N1 influenza epidemic. American Journal of Infection Control. 2010;38(5):374-80.
17. Seale H, Mak JP, Razee H, MacIntyre CR. Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza. BMC public health. 2012;12(1):307.
18. Wong CY, Tang CSK. Understanding heterosexual Chinese college students' intention to adopt safer sex behaviors. Journal of Sex Research. 2001;38(2):118-26.
19. Baker CW, Little TD, Brownell KD. Predicting adolescent eating and activity behaviors: the role of social norms and personal agency. Health Psychology. 2003;22(2):189.
20. Karimy M, Zareban I. Predictors of HIV-Preventive Behavior Changes Among HIV-Infected Patients in Iran: Application of the Extended Health Belief Model. International Journal of High Risk Behaviors and Addiction. 2018;7(4):e58145.
21. Vieno A, Santinello M, Pastore M, Perkins DD. Social support, sense of community in school, and self‐efficacy as resources during early adolescence: an integrative model. American journal of community psychology. 2007;39(1-2):177-90.
22. Coe AB, Gatewood SB, Moczygemba LR. The use of the health belief model to assess predictors of intent to receive the novel (2009) H1N1 influenza vaccine. Innovations in pharmacy. 2012;3(2):1-11.
23. Ferng YH, Wong-McLoughlin J, Barrett A, Currie L, Larson E. Barriers to Mask Wearing for Influenza‐like Illnesses Among Urban Hispanic Households. Public Health Nursing. 2011;28(1):13-23.
24. Berrigan D, Dodd K, Troiano RP, Krebs-Smith SM, Barbash RB. Patterns of health behavior in US adults. Preventive medicine. 2003;36(5):615-23.
25. Lagerlund M, Hedin A, Sparén P, Thurfjell E, Lambe M. Attitudes, beliefs, and knowledge as predictors of nonattendance in a Swedish population-based mammography screening program. Preventive medicine. 2000;31(4):417-28.
26. Sapp SG. Incomplete knowledge and attitude-behavior inconsistency. Social Behavior and Personality: an international journal. 2002;30(1):37-44.